Anti-synthetase syndrome is associated with a higher risk of hospitalization among patients with idiopathic inflammatory myopathy and COVID-19

Front Immunol. 2024 Mar 4:15:1295472. doi: 10.3389/fimmu.2024.1295472. eCollection 2024.

Abstract

Background: Data with fine granularity about COVID-19-related outcomes and risk factors were still limited in the idiopathic inflammatory myopathies (IIMs) population. This study aimed to investigate clinical factors associated with hospitalized and severe COVID-19 in patients with IIMs, particularly those gauged by myositis-specific antibodies.

Methods: This retrospective cohort study was conducted in the Renji IIM cohort in Shanghai, China, under an upsurge of SARS-CoV-2 omicron variant infections from December 2022 to January 2023. Clinical data were collected and analyzed by multivariable logistic regression to determine risk factors. High-dimensional flow cytometry analysis was performed to outline the immunological features.

Results: Among 463 infected patients in the eligible cohort (n=613), 65 (14.0%) were hospitalized, 19 (4.1%) suffered severe COVID-19, and 10 (2.2%) died. Older age (OR=1.59/decade, 95% CI 1.18 to 2.16, p=0.003), requiring family oxygen supplement (2.62, 1.11 to 6.19, 0.028), patients with anti-synthetase syndrome (ASyS) (2.88, 1.12 to 7.34, 0.027, vs. other dermatomyositis), higher IIM disease activity, and prednisone intake >10mg/day (5.59, 2.70 to 11.57, <0.001) were associated with a higher risk of hospitalization. Conversely, 3-dose inactivated vaccination reduced the risk of hospitalization (0.10, 0.02 to 0.40, 0.001, vs. incomplete vaccination). Janus kinase inhibitor (JAKi) pre-exposure significantly reduced the risk of severe COVID-19 in hospitalized patients (0.16, 0.04 to 0.74, 0.019, vs. csDMARDs). ASyS patients with severe COVID-19 had significantly reduced peripheral CD4+ T cells, lower CD4/CD8 ratio, and fewer naive B cells but more class-switched memory B cells compared with controls.

Conclusion: ASyS and family oxygen supplement were first identified as risk factors for COVID-19-related hospitalization in patients with IIMs. JAKi pre-exposure might protect IIM patients against severe COVID-19 complications.

Keywords: COVID-19; JAK inhibitor; anti-synthetase syndrome; idiopathic inflammatory myopathy; interstitial lung disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19* / complications
  • COVID-19* / therapy
  • China / epidemiology
  • Humans
  • Ligases
  • Myositis* / complications
  • Myositis* / epidemiology
  • Oxygen
  • Retrospective Studies
  • SARS-CoV-2

Substances

  • Ligases
  • Oxygen

Supplementary concepts

  • SARS-CoV-2 variants

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. QF's work is supported by National Natural Science Foundation of China Grant (82371805), Shanghai Municipal Science and Technology Fund (21ZR1438800, 22Y11902400), Shanghai Immune Therapy Institute and the Shanghai Hospital Development Center (SHDC) (No. SHDC2023CRD012). WW's work is supported by the Science and Technology Commission of Shanghai Municipal Jiading District (JDKW-2023-0021). RW's work is supported by Science and Technology Innovation Plan of Shanghai Science and Technology Commission (23YF1423000).